Compartment Syndrome Flashcards
(22 cards)
Six P’s (Signs and Symptoms of Compartment Syndrome)
Pain Pressure Pulselessness Paresthesia Pallor Paralysis
Pain - Signs & Symptoms (S&S)
Pain: primary symptom in awake patient
Pain - Key Points
Pain is NOT a reliable symptom in patients who are unconscious, insensate, or patients with a nerve block
Pain out of proportion:
- Increases with passive motion (stretch test)
- Unrelieved by analgesics, loosening of cast, dressing, splint
- In late stage, pain may not be present if ACS already established, as receptors and nerve fibers may face ischemic necrosis and death
Pain - Assessment
- Passive stretch test: extension/hyper-extension of toes, fingers
- Use validated pain scales for individual type of patient
Pain - Interventions
- Relieve the pressure with positioning
- Loosen cast, bandage, splint, tourniquet, compression stockings
- Position extremity at heart level (do not elevate)
- Communicate findings to provider, surgeon
- Treat pain
- When not improving, ICP (Intracompartmental Pressure) measurement warranted
Pressure - Key Points
- Massive swelling
- Tense feeling of muscle(s) on palpation
Pressure - Assessment
-Results can be variable secondary to severe pain and/or peripheral nerve block
Pressure - Interventions
- Communicate findings to provider, surgeon
- ICP (Intracompartmental Pressure) measurement warranted
Pulselessness - Key Points
-Very late sign signaling potential for tissue necrosis
Pulselessness - Assessment
-Palpate all pulses distal to injury
(Doppler ultrasound may be useful)
-Assess for capillary refill delay greater than three seconds
Pulselessness - Interventions
- Urgently notify provider, surgeon of finding
- ICP measurement
- Fasciotomy (a surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle)
Paresthesia - S&S
Burning or prickling sensation
Paresthesia - Key Points
- First sign of nerve ischemia
- May be compounded by nerve block
Paresthesia - Assessment
-Presence of burning, numbness or tingling
Paresthesia - Interventions
- Notify provider, orthopedic surgeon immediately
- ICP measurement
Palor - Assessment
-Skin color changes compared to unaffected extremity
Palor - Intervention
-Notify provider, surgeon, orthopedic surgeon
Paralysis - Key Points
-Neurovascular deficits can cause muscles in the affected compartment to become weak/paralyzed
Paralysis - Assessment
-Establish ability to move affected extremity
Paralysis - Interventions
Notify provider, surgeon, orthopedic surgeon immediately
Normal intracompartmental extremity measurement
ranges from 0 to 4 mmHg
Methods of diagnosing ACS
- infrared spectroscopy monitoring and noninvasive ultrasound techniques to measure tissue perfusion
- Magnetic resonance imaging can also play a role in the diagnosis of ACS.
- Continuous pressure monitoring can be useful when diagnosing patients who are unable to communicate, or patients who have received a regional nerve block for postoperative analgesia.
- pressure measurement value considered necessary for diagnosing extremity ACS is equivocal depending on the anatomic location and the measurement location in relation to the injury site.
- There is currently no consensus on the threshold compartment pressure at which a fasciotomy is needed, yet traditional recommendations for decompression have suggested pressure above 30 mmHg.
- Another method to determine the need for fasciotomy is based on the delta between compartment pressure and blood pressure. The delta pressure is obtained by subtracting the compartment pressure from the diastolic pressure.
- The use of delta pressures less than or equal to 30 mmHg has been shown to be an effective method in diagnosing compartment syndrome in a timely and accurate manner.
